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Local Anesthetic Formulations

4 CE Credits

You will receive 4 units of continuing education credit upon successful completion of this course.

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ADA Member: $112.00
Nonmember: $168.00
Dental Team Member: $60.00

Author:

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Daniel Becker

Learning Objectives:

Upon completion of this course, participants should be able to do the following:
  1. Explain the mechanism of action for local anesthetics and correlate chemical and physical properties with their clinical characteristics.
  2. Calculate the dose of local anesthetic and vasopressor included in anesthetic cartridges.
  3. Explain principal variables that influence systemic concentration following submucosal injections and describe systemic complications associated with local anesthetics, including their metabolites.
  4. Discuss issues regarding allergic reactions to local anesthetics and appropriate management of patients presenting a history of hypersensitivity.
  5. Explain the advantages of including vasopressors in local anesthetic solutions and state the effects mediated by each of the three principal adrenergic receptors.
  6. Distinguish the hemodynamic influences of epinephrine and levonordefrin and describe the appropriate use of these agents for patients with cardiovascular disorders.
  7. Explain the basis for putative interactions of vasopressors with antidepressants and nonselective beta-blockers, including appropriate management of patients receiving these medications.
     

Abstract:

This course is an update on the pharmacology and rational use of local anesthetics, those with and without vasopressors. Which anesthetics do you use and why? Do you really know the difference or do you select by habit? This course will review and update your knowledge on the appropriate use of local anesthetics and vasopressors and address the necessary precautions and potential drug interactions.

Outline:

  1. General Properties of Local Anesthetics

  2. Clinical

  3. Molecular

  4. System Toxicity

  5. Dosage

    1. Systemic Serum Concentration

    2. Metabolites

    3. Allergy

  6. Agent Comparisons

    1. Maximum Dosages

  7. Vasopressors

    1. Cardiovascular Disease

      1. Epinephrine

      2. Levonordefrin

References:

  1. Scott DB, Jebson PJR, Braid DP, et al. Factors affecting plasma levels of lignocaine and prilocaine. Brit J Anaesth 1972; 44: 1040-9.
  2. Prchal JT, Gregg X. Hemoglobinopathies: Methemoblobinemias, polycythemias and unstable hemoglobins. In: Goldman L, Ausiello D Editors. Cecil Textbook of Medicine. 22nd edition. Philadelphia: W.B. Saunders Co., 2004.
  3. Berkun Y, Ben-Zvi A, Levy Y, Galili D, Shalit M. Evaluation of adverse reactions to local anesthetics: experience with 236 patients. Ann Allergy Asthma Immunol 2003; 91(4):342-5.
  4. Adkinson Jr. NF. Drug Allergy. In: Adkinson Jr. NF, Yunginger JW, Busse WW, et al. (Editors): Middleton's Allergy: Principles and Practice, 6th ed., Philadelphia: Mosby, Inc; 2003.
  5. Yagiela JA. Local anesthetics. In: Dionne RA, Phero JP, Becker DE. Management of Pain & Anxiety in the Dental Office. W.B. Saunders / Elsevier Science Pub, St. Louis, 2002.
  6. Mikesell P, Nusstein J, Reader A, Beck M, Weaver J. A comparison of articaine and lidocaine for inferior alveolar nerve blocks. J Endod 2005; 31(4):265-70
  7. Haas DA, Lennon D. A 21 year retrospective study of reports of paresthesia following local anesthetic administration. J Can Dent Assoc. 1995;61(4):319-30.
  8. Dagher FB, Yared GM, Machtou P. An evaluation of 2% lidocaine with different concentrations of epinephrine for inferior alveolar nerve block. J Endod. 1997;23(3):178-80.
  9. Tofoli GR, Ramacciato JC, de Oliveira PC, et al. Comparison of effectiveness of 4% articaine associated with 1: 100,000 or 1: 200,000 epinephrine in inferior alveolar nerve block. Anesth Prog. 2003;50(4):164-8.
  10.  Westfall TC, Westfall DP. Adrenergic agonists and antagonists. In: Brunton LL, Lazo JS, Parker KL. Eds. Goodman and Gilman's The Pharmacological Basis of Therapeutics. 11th edition. New York: McGraw-Hill, 2006.
  11. Becker DE. Clinical implications of autonomic pharmacology. J Oral Maxillofac Surg 1992; 50: 734- 740.

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